Hepatobiliary - Acute and Chronic Pancreatitis, Cirrhosis Flashcards
Acute Pancreatitis - what is acute pancreatitis?
ENZYME - MEDIATED AUTODIGESTION
Pancreas becomes inflamed
Pancreatic damage happens when the digestive enzymes are activated before they are released into small intestine, and so begin attacking the pancreas
It causes reversible damage
Acute Pancreatitis - what are the causes?
G - Gallstones
E - Ethanol
T - Trauma
S - Steroids M - Mumps/malignancy A - Autoimmune S - Scorpion sting H - Hyperlipidaemia/hypercalcaemia E - ERCP D - Drugs (azathioprine, mesalazine, bendroflumethiazide)
Acute Pancreatitis - what are the symptoms
Severe epigastric pain that may radiate to back
N+V
Acute Pancreatitis - what are the signs?
Grey Turners sign - bruising of the flanks
Cullen’s sign - superficial oedema with periumbilical bruising
Jaundice
Acute Pancreatitis - what are the blood test investigations?
Serum amylase - usually 3 times the upper limit of normal levels
Serum lipase - more useful for catching late presentations, more sensitive and specific
MOST IMPORTANT TWO TESTS
Bloods - FBC, U&Es, LFTs, CRP
ABG
Acute Pancreatitis - what scans can you do?
US
AXR
CT/MRI
Acute Pancreatitis - what are the early and late complications?
EARLY:
1. Shock
- ARDS - Acute Respiratory Distress Syndrome
- Sepsis
LATE:
- Bleeding
- Pseudocyst - results from collection of peripancreatic fluid collection, occur ≥ 4 weeks after acute attack
- Pancreatic abscesses - intraabdominal collection of pus associated with pancreas, typically a result of infected pseudocyst
- Pancreatic necrosis - involve both pancreatic parenchyma and surrounding fat
Acute Pancreatitis - what is the treatment?
Nil by mouth
I.V. saline
Analgesia
O2
Surgery
ITU
Chronic Pancreatitis - what is it?
Repeated bouts of acute pancreatitis, and so persistent inflammation
Chronic Pancreatitis - what structural changes occur to the pancreas?
Irreversible changes
Fibrosis, atrophy, calcification
This gradual process of pancreatic tissue getting replaced by mis-shaped ducts, fibrosis and calcium deposits, is chronic pancreatitis
Chronic Pancreatitis - most common cause?
Alcohol
Chronic Pancreatitis - what are the other causes?
- Autoimmune
- CF
- Hereditary
- Pancreatic duct obstruction
Chronic Pancreatitis - what are the clinical features?
- Epigastric pain radiating to back (relieved by sitting forward)
- Jaundice
- Weight loss
- Steatorrhea
Chronic Pancreatitis - what are the 1st line imaging methods?
Abdo US and CT - pancreatic calcifications confirm diagnosis
Chronic Pancreatitis - what is the management?
Drugs:
- Analgesia
- Lipase
- Fat-soluble vitamins
- Insulin (amount needed may be variable)
Diet:
- No alcohol
- Low fat
Surgery:
1. Pancreatectomy or pancreatojejunostomy